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El algoritmo de 2025 para la función diastólica ecocardiográfica se asocia con una mejor estratificación del riesgo
Kenya Kusunose1, Sae Ooka1, Hirotsugu Yamada2
1Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Resumen
La guía de función diastólica de 2025 elimina los casos indeterminados y mejora la predicción de riesgos en pacientes con insuficiencia cardíaca. Este nuevo algoritmo mejora la estratificación pronóstica y ayuda en el manejo de la insuficiencia cardíaca (IC).
Área de la Ciencia:
- Cardiología
- Ecocardiografía
- Manejo de la Insuficiencia Cardíaca
Sus antecedentes:
- La guía de función diastólica ASE/EACVI de 2016 dio lugar a frecuentes clasificaciones 'indeterminadas' y a una estratificación del riesgo inconsistente.
- Una guía actualizada de 2025 introdujo un algoritmo escalonado para minimizar los casos indeterminados y mejorar la precisión pronóstica.
Objetivo del estudio:
- Evaluar si la guía de función diastólica de 2025 reduce las clasificaciones indeterminadas en comparación con el estándar de 2016.
- Evaluar si la nueva guía mejora la estratificación pronóstica en pacientes con insuficiencia cardíaca (IC).
Principales métodos:
- Análisis retrospectivo de 156 pacientes hospitalizados con IC que se sometieron a ecocardiografía antes del alta.
- Clasificación de la función diastólica utilizando los algoritmos de 2016 y 2025.
- Análisis de 300 pacientes ambulatorios para explorar la aplicabilidad en etapas más tempranas de la IC.
Principales resultados:
- El algoritmo de 2025 eliminó las clasificaciones indeterminadas (de 23 a 0) y redistribuyó la calificación.
- Los niveles de BNP y los resultados clínicos mostraron aumentos escalonados más claros con los criterios de 2025.
- La presión elevada de la aurícula izquierda (PAI) según el algoritmo de 2025 se asoció de forma independiente con resultados adversos (IMC, 3,56; P=0,001) y mejoró la discriminación del riesgo al añadirse a la puntuación HOSPITAL (estadístico c de 0,63 a 0,73).
Conclusiones:
- El algoritmo diastólico de 2025 eliminó eficazmente las clasificaciones indeterminadas y mejoró la estratificación pronóstica en pacientes hospitalizados con IC.
- La guía actualizada mejoró la discriminación del riesgo más allá de las puntuaciones clínicas existentes.
- Los datos exploratorios sugieren una posible aplicabilidad en etapas más tempranas de la IC, lo que justifica una validación prospectiva.
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